Burden of Secondary Hyperparathyroidism Among Patients on Hemodialysis: A Cross-Sectional Study

TL;DR

This study found that nearly 20% of hemodialysis patients have secondary hyperparathyroidism, with higher rates in males and those with diabetes or high blood pressure.

Contribution

The study provides new prevalence data on SHPT in hemodialysis patients in Khyber Pakhtunkhwa, Pakistan.

Findings

25 out of 127 (19.7%) hemodialysis patients had SHPT based on KDIGO guidelines.

SHPT was more common in males, those with longer dialysis duration, diabetes, and hypertension.

Abstract

Background: Secondary hyperparathyroidism (SHPT) is a frequent complication in patients with end-stage renal disease (ESRD) undergoing hemodialysis. It results from imbalances in calcium, phosphate, and vitamin D metabolism due to impaired renal function.

Objective: This study aimed to determine the frequency of SHPT among hemodialysis-dependent ESRD patients in a tertiary care hospital in Khyber Pakhtunkhwa.

Methods: A cross-sectional study was conducted in the Nephrology Department of Lady Reading Hospital, Peshawar, from August 2023 to January 2024. A total of 127 patients between 18 and 75 years of age, undergoing maintenance hemodialysis for at least six months, were included. SHPT was defined in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) 2017 guidelines as an intact parathyroid hormone (iPTH) level greater than nine times the upper reference limit in hemodialysis patients. Data were analyzed using IBM SPSS Statistics for Windows, version 25, with stratification based on age, dialysis duration, diabetes status, and hypertension.

Results: Out of 127 patients, 25 (19.7%) were found to have SHPT. The mean age of the study population was 51.8 ± 15 years, with 77 (60.6%) males and 50 (39.4%) females. Diabetes was present in 70 (55.1%) patients, while 83 (65.4%) were hypertensive. SHPT was observed more frequently among male patients, those with a longer duration of dialysis, and individuals with coexisting diabetes and hypertension.

Conclusion: SHPT was identified in nearly one-fifth of hemodialysis patients, with higher prevalence among males, diabetics, hypertensives, and those on prolonged dialysis. These findings highlight the importance of regular biochemical monitoring and early intervention to reduce SHPT-related complications and improve long-term outcomes in hemodialysis-dependent patients.